title: The impact of skin damage due to cutaneous lupus on quality of life.
abstract: BACKGROUND
  Patients with more severe cutaneous lupus erythematosus (CLE) have a poorer quality of life (QoL). Racial and ethnic disparities have been reported in disease activity and outcomes in systemic lupus erythematosus, but similar information is not available for CLE.
  
  
  OBJECTIVE
  To evaluate the impact of lupus-related skin damage on skin-specific QoL, and to analyse differences stratified by ethnic background.
  
  
  METHODS
  Data collected included sex, race, diagnosis and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Skindex-29 scores. These parameters were analysed at the initial and last visits. CLASI damage scores (dyspigmentation and scarring) and activity scores were collected, grouped by ethnicity, and correlated with Skindex-29. Overall, 223 patients were analysed at baseline, with 141 completing more than one study visit.
  
  
  RESULTS
  The majority of patients were white (63·7%), followed by African American (29·1%) and Asian American (4·0%). African American patients accounted for a disproportionate percentage of both localized (50%) and generalized discoid lupus erythematosus (DLE) (49%). Median CLASI damage scores differed significantly between the African American, white and Asian American patients, at both the first (8·5, 4·0, 7·0, respectively; P < 0·0001) and last visit (10·0, 6·0, 8·5, respectively; P < 0·01). CLASI damage scores in African Americans correlated with CLASI activity scores (Spearman r = 0·45, P = 0·0003).
  
  
  CONCLUSIONS
  There was no significant correlation between CLASI damage scores and Skindex domains overall. Individually, dyspigmentation and scarring also did not have a significant effect on QoL. Ethnic differences in patients with CLE were found: African American patients exhibited a high rate of DLE and experienced damage early in their disease course, frequently in conjunction with disease activity.
authors.affiliation: Department of Dermatology, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, U.S.A; Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: S M
authors.initials: SM
authors.lastname: Verma
authors.forename: J
authors.initials: J
authors.lastname: Okawa
authors.forename: K J
authors.initials: KJ
authors.lastname: Propert
authors.forename: V P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002921:Cicatrix / Q000208:ethnology / Q000473:pathology / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000208:ethnology / Q000473:pathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000208:ethnology / Q000473:pathology / Q000523:psychology; D011788:Quality of Life; D044469:Racial Groups / Q000208:ethnology*; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology; D055815:Young Adult